Healthcare Provider Details

I. General information

NPI: 1699474031
Provider Name (Legal Business Name): MARIN STAUFFACHER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MILWAUKEE ST STE 507
JANESVILLE WI
53545-3004
US

IV. Provider business mailing address

101 E MILWAUKEE ST STE 507
JANESVILLE WI
53545-3004
US

V. Phone/Fax

Practice location:
  • Phone: 608-728-7774
  • Fax: 608-621-3804
Mailing address:
  • Phone: 608-728-7774
  • Fax: 608-621-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7279-27
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-23-259875
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: